Oral piercings and their complications - How confident are we as a profession?

Abstract

Introduction
The prevalence of oral piercings in the UK is increasing. Consequently, the dental profession is encountering an increasing number of complications associated with piercings. Providing patient preventative advice regarding piercing complications is important, however the level of advice offered by UK dentists is currently unknown.

Aims
The aim of this survey was to establish the current knowledge, attitudes and behaviours of dentists regarding advice provided to patients with oral piercings.

Methods
A questionnaire was sent to 200 dentists across Wales with questions regarding perceived confidence in providing advice, type of advice provided, the sources dentists use to acquire knowledge and the perceived need for further professional information.

Results
Fifty-three dentists responded. Only 24.5% were very confident discussing piercing complications. The advice provided varied markedly, with the majority (73.6%) reporting they had acquired knowledge through experience alone. Only one dentist reported providing written information and 83% responded that they would like to have access to printed information directed at patients.

Conclusions
The results of this survey suggest that dental professionals are not fully confident discussing risks and preventative advice with patients. To address this, patient information leaflets have been developed to encourage dentists to discuss complications associated with oral piercings with patients.

Full text

Oral piercings and their complications –
how confident are we as a profession?
E. M. King,*1 E. Brewer2 and P. Brown1
and in May 2017 a new Public Health (Wales)
Bill was accepted by the National Assembly
for Wales to ban all intimate piercing, which
includes tongue piercing, before the age of
18. To establish the current attitudes of the
dental profession towards oral piercings, a
Introduction
Body modication, the purposeful alteration
of normal human anatomy to achieve a desired
appearance, is a popular practice that has led
to a rise in the prevalence of oral piercings. In
1992, the rst report relating to oral piercing
appeared in the dental literature titled ‘Tongue
piercing: a new fad in body art’.1 However,
rather than a fad, oral piercings have become
increasingly popular. Common sites for oral
piercings include the tongue (Fig. 1) and lips
(Fig. 2) however piercing of alternative ana-
tomical sites such as the cheeks (Figs 3and 4)
and frenulae (Fig. 5), is becoming more
prevalent.2,3 Oral piercings have been a recent
topic of debate in the Welsh Government,
Introduction The prevalence of oral piercings in the UK is increasing. Consequently, the dental profession is encountering
an increasing number of complications associated with piercings. Providing patient preventative advice regarding piercing
complications is important, however the level of advice offered by UK dentists is currently unknown. Aims The aim of this
survey was to establish the current knowledge, attitudes and behaviours of dentists regarding advice provided to patients with
oral piercings. Methods A questionnaire was sent to 200 dentists across Wales with questions regarding perceived confidence
in providing advice, type of advice provided, the sources dentists use to acquire knowledge and the perceived need for
further professional information. Results Fifty-three dentists responded. Only 24.5% were very confident discussing piercing
complications. The advice provided varied markedly, with the majority (73.6%) reporting they had acquired knowledge through
experience alone. Only one dentist reported providing written information and 83% responded that they would like to have
access to printed information directed at patients. Conclusions The results of this survey suggest that dental professionals are
not fully confident discussing risks and preventative advice with patients. To address this, patient information leaflets have been
developed to encourage dentists to discuss complications associated with oral piercings with patients.
national survey was conducted among General
Dental Practitioners (GDPs) across Wales.
Furthermore, a literature review was conducted
to establish the current global trends in oral
piercings and discuss the potential complica-
tions resulting from such body modications.
1Morriston Hospital, Restorative Dentistr y, Heol Maes
Eglwys, Morriston, Swansea, SA6 6N L, United Kingdom
2Oral Surgery, Prince Charles Hospital, Merthy r Tydfil, CF47
9DT, United Kingdom
*Correspondence to: Elizabeth King
Email: elizabeth.king@hotmail.com
Referee d Paper. Accepted 5 January 2018
DOI: 10.1038/sj.bdj.2018.435
Key points
Educates the reader about the
prevalence of oral piercings and their
complications.
Discusses the types of complications
associated with oral piercings.
Updates the reader about the
legislation and legal requirements
regarding oral piercings.
Provides an example of a patient
information leaflet that can be
used when discussing oral piercing
complications with patients.
Fig. 1 Midline tongue piercing with stainless steel tongue bar (barbell)
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Legislation
Following the death of a Sheeld teenager
from septicaemia caused by a lip piercing in
2002, the risks of body piercing were discussed
in the House of Commons.4,5 As a result, a
voluntary code of practice was implemented
for piercers which included guidance regarding
the practice of body piercing, specic recom-
mendations for hygienic procedures, checking
medical history before piercing and the
prevention of piercing individuals below 16
years of age unless parental consent is given.
is code of practice is summarised in the
document ‘Advice and Safe Practice for Body
Piercing – Guidance for Operators’ produced
by the British Body Piercing Association.6 It is
unknown how many piercers have adopted this
code of practice and therefore compliance can
vary between establishments.
Currently the legislation for licensing
and registration of piercing establishments
varies between local authorities. In England
and Wales, local authorities have the power
to apply the Health and Safety at Work Act
1974 to impose infection control and safety
requirements.7 Furthermore, there are speci-
fications stated in the Local Government
(Miscellaneous Provisions) Act 1982 and
the Local Government Act 2003 for local
authorities in England and Wales to require
the registration of individuals providing body
piercings.8 e Local Government Act 2003
also stipulates standards of cross infection
control. With the aim of preventing transmis-
sion of infectious diseases, the Health and
Safety Executive have produced the SR12
publication to help piercers comply with the
Control of Substances Hazardous to Health
Regulations (COSHH) 2002.9 Local authori-
ties can choose whether to adopt and enforce
these guidelines in addition to their own
byelaws; therefore piercing standards vary
across theUK.
While many piercing establishments enforce
their own age restrictions, there are currently
no laws restricting piercings for minors
in England. Many local authorities have
developed licensing frameworks that make
it possible to state a minimum age; however
there are inconsistencies across the UK. Some
local councils prohibit cosmetic piercing under
16 years of age whereas some state 18 years
ofage.10–12 In Scotland, individuals under 16
are required to have parental consent before
undergoing any piercing. In Northern Ireland,
the piercing of nipples and genitalia of children
Fig. 2 Lip piercing (also termed labret) with a titanium lip bar
Fig. 3 Cheek piercing viewed intra-orally with titanium bar in situ
Fig. 4 Cheek piercing viewed extra-orally
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under the age of 16 is regarded as indecent
assault under sexual oences legislation, and
can lead to prosecution.
e Welsh Government has raised serious
concerns about the medical implications
associated with intimate piercings, and the
potential vulnerability of young people
receiving such piercings. In 2015, the Welsh
Government introduced a Public Health
(Wales) Bill which included a clause to ban
all intimate piercing before the age of 18. e
Welsh Dental Committee (WDC) responded
to the consultation and strongly suggested
that intimate piercing should include tongue
piercing, and as a result tongue piercing was
added to the list of intimate piercings. e
Public Health (Wales) Bill was accepted by the
National Assembly for Wales in May 2017 and
the age for intimate piercing, including tongue
piercing, has been raised to 18 years old. is is
now in keeping with similar legislation such as
tattooing of minors and female genital mutila-
tion. e age increase will help to avoid cir-
cumstances where young people are placed in
potentially vulnerable situations, particularly
where there is risk to the developingbody.13
Complications
Unsurprisingly, oral and peri-oral piercings
are associated with numerous complications.
e UK incidence of complications associated
with oral piercings is reported by Boneetal.
(2008).2 In 16–24-year-olds, 50.1% who had
tongue piercings and 20.5% who had lip
piercings experienced complications. Tongue
piercing was the second most common body
piercing resulting in complications (following
the navel). is nding corroborates other
studies which state that complications are most
prevalent with tongue piercings, followed by
lip, cheek and gingivae.3,14,15
It is currently unknown how many patients
with oral piercings attend for emergency
treatment in the UK. In 2006, a UK-based
survey of 126 piercees reported that 99%
had problems with their tongue piercing,
7% of which required healthcare following
the piercing.16 A US study of 100 emergency
departments has reported an estimated annual
presentation rate of 3,494 injuries associated
with oral piercings.14 In this study, patients
aged 14 to 22 years old accounted for 73% of
the emergencyvisits.
Several investigations have aimed to identify
the prevalence of the dierent complications
associated with oral piercings (Table 1).
Commonly reported acute complications
include pain, swelling, haemorrhage, infection
and masticatory and speech impairment. Less
frequently reported immediate complica-
tions include haematoma, delayed healing,
puncture wound, laceration, dental trauma,
allergy, dysphagia and hypersalivation.14,15,17–21
Commonly reported chronic complications
include pain, infection, swelling, bleeding,
tissue hyperplasia, so tissue trauma, gingival
recession, dental trauma, dental pain, speech
impairment, taste disturbances and ingestion
of piercing. Less frequently reported chronic
complications include masticatory/eating
impairment, gingivitis, plaque accumulation
(Fig. 5), hypersalivation, galvanic reaction,
tooth migration and dysphagia.14,16–21
Complications have been shown to be more
common in patients who habitually play with
their piercing.15
Several rare and sometimes serious oral
piercing complications have been reported
(Table 2).22 Prior to the enforcement of
COSHH regulations, it was hypothesised that
oral piercings could increase the risk of trans-
mission of blood borne viruses such as HIV
and hepatitis B andC.23
It is essential that all professions who
encounter oral piercings are properly informed
and able to provide advice regarding oral
piercing complications. e level of advice
oered by UK dental professionals regarding
oral piercings is currently unknown. ere
is no current consensus among dental pro-
fessionals regarding the type of complica-
tions that should be discussed with patients.
There many easily available advice leaflets
developed for the piercing industry, however
similar documentation does not exist for the
dental profession. To investigate the current
knowledge, attitudes and behaviours of UK
dentists regarding advice provided to patients
with oral piercings, a survey was distributed
to GDPs in Wales. e results are discussed,
and advice is provided for dental professionals
treating patients with oral piercings.
Methodology
A multiple-choice questionnaire was developed
with the aim of documenting dentists’
perceived confidence in discussing oral
piercings, information provided to patients
regarding complications, methods used to
provide patients with information, sources
dentists are using to acquire their knowledge
and whether further support or information
is required. An example of the questionnaire
is presented in Figure6.
Inclusion criteria consisted of GDPs working
in primary care in the Betsi Cadwaladr
University Health Board (North Wales) and
the Bro Taf Health Authority (covering Cardi,
Merthyr Tydl, Rhondda Cynon Ta and the
Vale of Glamorgan in South Wales). e ques-
tionnaire was sent via electronic mail using
Microso Oce Soware.
Results
Two hundred GDPs were approached to
complete the questionnaire with a total of 53
GDPs (26.5%) returning completed surveys.
Results were collated and analysed using
MicrosoExcel.
Fig. 5 Piercing of the lingual frenulum with stainless steel bar in place. Note the
accumulation of plaque on the ball ends of the piercing
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Table 1 Commonly reported complications of oral and peri-oral piercings in the dental and medical literature (cont. on p891)
Study Number of
patients
Number of pierc-
ings
Frequency of oral piercing complications
Acute %Chronic %
De Moor et al. 200517
Patient questionnaire + examination 50 55
(47 tongue; 8 lip)
Swelling 22 Speech impairment 14
Pain 14 Eating impairment 10
Haematoma 4 Soft tissue trauma 2
Infection 2
Delayed healing 2
Haemorrhage 2
Levin et al. 200519
Patient questionnaire + examination 79 79
Swelling 52.9 Gingival recession 26.6
Haemorrhage 45.7 Dental trauma 13.9
Bleeding 13.9
Infection 11. 4
Gingivitis 5.1
Chadwick et al. 200518
Dentist questionnaire 227 –Not reported
Dental trauma 100
Gingival recession 42.6
Swelling 35.8
Infection 34.7
Speech impairment 30.6
Pain 23.8
Plaque deposits 22.7
Tissue hyperplasia 18.2
Bleeding 9
Tooth migration 2.8
Hypersalivation 2.3
Dysphagia 2.3
Galvanic reaction 2.3
Ingest piercing 1.1
Stead et al. 200616
Patient questionnaire 126 126 (ton gu e)
Swelling 90 Ingest piercing 29
Pain 69 Dental trauma 28
Eating impairment 63 Plaque deposits 26
Speech impairment 43 Speech impairment 9
Haemorrhage 42 Swelling 7
Ingest piercing 5Eating impairment 2
Dental trauma 4Pain 1
Plaque deposits 4Bleeding 1
Vieira et al. 201021
Patient questionnaire + examination 39 42
(37 tongue; 5 lip)
Haemorrhage 69 Pain 92.2
Pain 52.4 Soft tissue trauma 64.3
Faint 4.8 Swelling 61.9
Infection 3 8.1
Dental pain 33.3
Tissue hyperplasia 31
Bleeding 28.6
Gingival recession 4.8
Dental trauma 2.4
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GDP confidence
When asked how respondents felt about dis-
cussing oral piercing advice with patients,
24.5% (N = 13) replied very confident,
49% (N= 26) were moderately confident
and 26.5% (N= 14) not confident (Fig. 7).
Information provided to patients has pre-
dominantly been acquired from experience
(N=39, 73.6%), and to a lesser extent from
dental training (N= 9, 17.0%). As part of
their Continuing Professional Development
(CPD), some GDPs have also read published
literature on the topic (N=15, 28.3%) and
one had researched their local authority
publications.
Complications
Warnings of piercing complications are given
by 50 (94.3%) of the respondents, all of whom
given verbal advice only. e three GDPs
(5.7%) who do not oer any information had
also answered that they were not condent in
discussing advice with patients.
ere were 15 complications described in
the survey, illustrated by Figure 8. None of
the respondents oered additional examples.
Understandably the most common complica-
tions discussed were trauma to teeth (N=46),
gingival recession (64.1%, N=34), and dentine
hypersensitivity (22.6%, N=12). Aside from
dental-related trauma, GDPs tend to warn of
acute complications such as infection (52.8%,
N=28), inammation (37.7%, N=20), and
pain (28.3%, N=15). Chronic complications,
such as scarring/ tissue hyperplasia (16.9%,
N=9), are described lessoen.
When complications arise, 19 GDPs (35.8%)
would advise on where to seek treatment. In
the rst instance, the majority (24.5%, N=13)
recommend seeking treatment from a dentist.
Secondary to this, patients are directed to
either return to their piercer (13.2%, N=7),
attend with their general medical practitioner
(11.3%, N= 6), or seek attention from their
local emergency department (13.2%, N=7).
Piercing advice
A large proportion of GDPs oered additional
guidance (94.3%, N= 50), demonstrated in
Figure 9. The 3 GDPs (5.7%) who lacked
condence acknowledged that they do not
discuss oral piercings with patients.
Advice is largely based on minimising the
risk of trauma to intra-oral tissues, hence
GDPs often advocate removing piercings
(45.2%, N=24). Two respondents who oered
‘Other’ information recommend replacing
metallic components of piercings with plastic
alternatives, particularly if there is ‘evidence of
damage to the lower anterior teeth.’ A quarter
of GDPs advise that patients attend for regular
dental examinations to monitor potential
problems (24.5%, N=13). Where piercings
are kept in situ, patients are discouraged from
regularly ‘playing’ with or touching/rotating
the piercing (35.8%, N=19). Hygiene guidance
is provided by 13 (24.5%) respondents.
Again, the preferred method of deliver-
ing advice is verbally (N= 44, 83.0%). One
respondent (1.9%) stated that they offer
written information, which is produced
in-house at the practice. A copy of this written
advice was not oered on return of the survey.
A number (N= 8, 15.1%) of GDPs did not
specify how their advice is delivered.
Table 1 Commonly reported complications of oral and peri-oral piercings in the dental and medical literature (cont. from p890)
Study Number of
patients
Number of pierc-
ings
Frequency of oral piercing complications
Acute %Chronic %
Hickey et al. 201015
Patient questionnaire + examination 201
201
(106 tongue; 88 lip; 7
cheek)
Eating impairment 78.3 Gingival recession 14.8
Speech impairment 67 Taste disturbance 12.3
Swelling 51.7 Dental trauma 7
Dysphagia 28.4
Hypersalivation 20.4
Gill et al. 201214
Retrospective epidemiological study 24,459
24,459
(10,341 to ng ue;
11,197 lip; 2,921 other)
Infection 42
Not reported
Puncture wound 29
Laceration 10
Haemorrhage 7
Dental trauma 7
Haematoma 1
Allergy 1
Plessas et al. 2012 22
Patient questionnaire + examination 110 161
(51 tongue; 110 lip)
Pain 57.7 Ingest piercing 48
Eating impairment 49 Gingival recession 39.7
Speech impairment 33.5 Bleeding 33
Haemorrhage 4.3 Dental trauma 32.3
Plaque deposits 21
Dental pain 13
Hypersalivation 9.3
Taste disturbance 6.8
Galvanic reaction 3
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GDP support
GDPs were asked what advice they would
like to receive in relation to managing oral
piercings in dental practice, summarised in
Figure 10. Largely, respondents preferred
printed information directed towards
patients (N= 44, 83.0%). Just over half of
GDPs indicated that they would like printed
information aimed at professionals (N=28,
52.8%), and 18 (34.0%) would like training
courses that provide veriableCPD.
Lastly, GDPs were asked their opinion of
existing publications relating to oral piercings.
Of the responses, 20 (37.7%) felt that available
publications are sucient; however, observa-
tions were made that materials are not readily
accessible. One individual remarked that they
‘could not nd information on where to seek
help if serious infection occurred.’ A total
of 13 (24.5%) respondents felt that current
publications are insucient, with two com-
menting that they hadn’t seen piercing-related
documents before this survey. Two GDPs
specied that patient information is inad-
equate. A proportion of GDPs were unfamiliar
with any publications (15.1%, N=8).
Discussion
Prevalence
The increasing incidence of oral piercings
appears to be a world-wide phenomenon. A
2012 systematic review studied the prevalence
of oral piercings in young adults from the
United Kingdom, Canada, Brazil, Spain, Israel,
the United States of America, New Zealand,
Germany and Finland. e results revealed
that 5.2% of the 9,104 young adults had an
oral piercing.3 e trend for such piercings
was higher in women (5.6%) than men (1.6%)
(M:F=3:11), with the most popular piercing
being the tongue (5.6%) followed by lips (1.5%)
and cheeks (0.1%). Oral piercings are most
common in 16-30 yearolds.2,3 Alarmingly,
several studies report oral piercings in indi-
viduals as young as 11-14 years of age.3,14,17,24
Bone et al. (2008)2 published the only
study that estimates the prevalence of body
piercings in the United Kingdom. This
survey of 10,503 adults found that 2.1% had
a piercing of the lip or tongue. When looking
specically at 16–24-year-olds, 9.2% reported
piercings of the lip and/or tongue. Females
(2.5%) were more likely than males (1.5%)
to opt for these types of piercings (M:F ratio
3:5). Most piercees received their piercing at
a dedicated studio. Similar evidence suggests
around 80% of piercings take place in piercing
establishments.25
Fig. 6 Example of questionnaire sent to GDPs
Not confident
Moderately confident
Very confident
24.5%26.5%
49%
Fig. 7 GDP confidence in delivering orofacial piercing education to patients
Table 2 Rare complications of oral and
peri-oral piercings22
Complication Number of
cases reports
Periodontitis 11
Endocarditis 8
Hypotensive collapse 1
Loss of inser tion needle 1
Ludwig’s angina 1
Fatal herpes simplex hepatitis 1
Thrombophlebitis of sigmoid sinus 1
Atypical trigeminal neuralgia 1
Bifid tongue 1
Airway obstruction 1
Cerebral abscess 1
Tetanus infection 1
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A 2016 survey was conducted by the Oral
Health Foundation, an independent UK
oral health charity, to establish the current
trends of oral piercings in theUK.26 Of 214
respondents, tongue piercings were the most
commonly reported (43%), followed by lip
(33%). Additionally, other anatomical sites
were described: frenulum (7%), cheek (3%)
and sites such as gingival piercings. 13% of
people with oral piercings had more than
one intra-oral site pierced, highlighting
their existing popularity among the UK
population.
e increased prevalence of oral piercings
has not gone unnoticed by the dental profes-
sion. A UK survey of 227 dentists in South
Wales revealed that 99% of dentists had
treated a patient with an oral piercing, over
three-quarters (77.5%) had seen a patient
for a complication caused by the piercing,
and over half (52.9%) had treated an oral
piercing complication.18 e British Dental
Association (BDA) released a position
statement in 2009 which advises against
oral piercings, and recommends that indi-
viduals with a piercing should regularly visit
a dentist and self-monitor the piercing site
for complications.27 Although the prevalence
of oral piercings is on the rise, the results
from this survey suggest that the condence
and knowledge within the dental profession
regarding oral piercings is not evolving with
this trend. It is therefore felt by the authors
that more should be done to educate the
dental profession about oral piercings.
0 10 20 30 40 50 60 70 80 90 100
Galvanic response
Allergy
Other
Masticatory impairment
Puncture wound
Speech impairment
Ingested/inhaled piercing
Tissue hyperplasia
Dentine hypersensitivity
Haematoma
Hamorrhage
Pain
Inflamation
Infection
Gingival recession
Dental trauma
% of GDPs
0 10 20 30 40 50
Other
Piercing hygiene
Regular dental exams
Discourage ‘playing’ with piercing
Remove piercing
% of GDPs
0
10
20
30
40
50
60
70
80
90
Training courses with
verifiable CPD
Information aimed at
professionals
Information aimed at
patients
% of GDPs
Fig. 8 Orofacial piercing complications described to patients by GDPs
Fig. 9 Orofacial piercing advice given to patients by GDPs
Fig. 10 Advice GDPs would like to receive in relation to the management of orofacial
piercings
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Awareness
Piercee awareness of potential oral piercing
complications varies. One study of 110 piercees
reported 70.9% were unaware that oral piercings
could aect their general health and 26.4% were
unaware of potential dental complications.24
Similar studies have reported that around
46–57.8% of piercees are unaware of the com-
plications associated with oral piercings.19,21
Information should initially be provided by
the establishment performing the piercing, both
before consenting an individual and aer per-
forming the piercing. Encouragingly, a recent
UK survey of piercers in South Wales reported
100% of piercers provided advice regarding oral
piercing complications, with 57% giving both
verbal and written warnings, 36% giving verbal
only, and 7% providing written warningsonly.28
However, warnings given by piercing studios
were diverse and no one piercer discussed
all relevant complications. Interestingly 79%
of piercers reported that further informa-
tion aimed at both piercing professionals and
piercees would be benecial.
Confidence among the dental
profession
It is evident from the results of this survey
that only a quarter of GDPs are very condent
in discussing with patients the nature of oral
piercing complications and necessary pre-
ventative advice. In comparison, a similar
UK survey conducted by Chadwick (2005)18
reported that nearly 88% of dentists felt they
could give adequate advice regarding possible
complications to patients who were consider-
ing having an oral piercing. is suggests con-
dence among the profession has fallen, which
may be a result of the increased prevalence and
complexity of oral piercings.
Most respondents disclosed that their
knowledge regarding oral piercings was learnt
from experience, with only a small number of
GDPs reporting they developed knowledge
through formal training or reading dental lit-
erature. is suggests there is a lack of access to
information and training available for dentists
in the UK. Furthermore, a large proportion of
respondents reported they would like informa-
tion leaets available for their patients. Many
reported they would like to receive further infor-
mation aimed at dentists and felt that there is a
need for CPD courses for dental professionals.
is highlights an area of dental education which
may currently be insucient for dental profes-
sionals to feel condent giving oral piercing
advice and treating complications.
It was reassuring to discover that the majority
of GDPs are providing patients with verbal
advice regarding oral piercing complications.
As one would expect, GDPs responded that
they regularly discuss dental related complica-
tions. Other common acute and chronic com-
plications appear to be discussed much less
frequently. is concurs with the UK study by
Chadwick (2005),18 whereby tooth fracture and
recession were the most commonly discussed
complications between GDPs and patients.18
It is apparent that in over ten years there has
not been any development in the information
provided by GDPs to patients regarding oral
piercing complications. As a visit to a dental pro-
fessional is an opportune moment for patients to
receive oral health advice, it is felt by the authors
that more needs to be done to empower dental
professionals to discuss the range of complica-
tions associated with oral piercings.
Encouragingly, almost all GDPs reported
the provision of preventative advice to avoid
oral piercing complications for their patients.
However, the advice regarding how to prevent
complications and where complications
should be treated varied among GDPs. It is
currently unknown how frequently piercees
in the UK seek medical or dental attention
for oral piercing complications. Considering
an estimated 2% of adults in the UK have an
oral piercing, it is likely that a large propor-
tion of this group of patients will require some
level of medical or dental care at somepoint.2
This therefore emphasises the importance
of the provision of clear and comprehensive
preventative advice for patients to reduce the
likelihood of complications.
As GDPs feel that current publications are
insucient and have indicated that they would
like further information available for patients
and dental professionals, the authors of this
article, together with 1000 Live Wales, have
developed patient information leaets which
have been distributed to GDPs in Wales to
enable them to discuss complications with
patients and provide written advice (Fig. 13).
It is important that all dental professionals
possess the appropriate skills and knowledge
to treat patients with oral piercings and are
condent to provide the correctadvice.
Limitations
As with all studies, there are certain limitations
that need to be recognized in this survey. Firstly,
the low response rate of 26.5% meant that a large
proportion of dentists’ experiences and opinions
were not captured in the data which may have
aected the results. It is possible that contact-
ing dentists via email led to a poorer response
rate than that which may have been achieved
by using a printed version of the survey sent
via post. It is also possible that due to the large
number of surveys dentists receive, the GDPs
targeted in this study may have experienced
‘survey fatigue’ which aected response rates.
e variation in prevalence of oral piercings
Fig. 11 Advice leaflet developed for dental professionals to discuss oral piercing
complications with patients. Courtesy of 1000 Lives Service Improvement Dental Team
RESEARCH
894 BRITISH DENTAL JOURNAL | VOLUME 224 NO. 11 | JUNE 8 2018

in the dierent Welsh regions targeted for this
survey is unknown. It is therefore possible
that the GDPs who responded may see a low
number of patients with oral piercings which
may explain the low condence and experience
treating piercing related complications.
Conclusion
Oral piercings are associated with numerous
complications, and it is possible that the
incidence of complications may increase as
the prevalence of oral piercings rises in the
UK population. It is important that dental
professionals can provide patients with
appropriate advice and manage oral piercing
complications that may arise. e results of
this survey suggest that dental professionals are
not entirely condent discussing risks and pre-
ventative advice with patients. To address this
issue, patient information leaets have been
developed to encourage dentists to discuss
complications associated with oral piercings
with patients.
Acknowledgements
e authors would like to thank the 1000 Lives Wales
team for help distributing the survey and designing the
information leaet.
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